Guide to Discussing Influenza Vaccine With Patients

Pharmacists in a community setting have a wide variety of conversations with patients on any given day. Exchanges can occur about home life, medical questions, where to locate a certain product in the store, or the best product for the common cold. Relatively few detailed conversations, however, center around the influenza (flu) vaccine. Most patients approach the pharmacy counter knowing whether or not they want to receive a flu vaccine that day, and most do not engage in a lengthy discussion. Flu vaccine conversations typically consist of patients asking, “Do you have the flu shot in stock?” followed by the operational workflow of the immunization.

Pharmacists, being easily accessible to the community, can offer a unique perspective when discussing the flu vaccine. They can generate conversations around annual flu vaccines that may not otherwise occur between a patient and a health care provider, because a patient might not require medical care or have any other reason to see a provider during peak flu vaccination times.

MOTIVATIONAL INTERVIEWING

Perhaps the most difficult conversations are with patients who are reluctant to get the flu vaccine. Patients may feel a need to get an annual flu vaccine because of concerns over their own health, concerns over a family member’s health, or societal pressure. Some patients have not ever received one before. Others have the strong belief—a widely held misconception—that they became infected with the flu from a previous flu vaccine.

Techniques such as motivational interviewing can make these conversations easier and lead to changes in patients’ behavior, ambivalent feelings, and insecurities.¹ A variant of the motivational interviewing technique is the elicit—provide–elicit model, which can be used during a brief patient interaction.² Using this model, the pharmacist would:

• Elicit: find out what the patient knows, or bet- ter ascertain the patient’s level of understand- ing, by asking questions of the patient directly;
• Provide: fill in knowledge gaps and/or remove misconceptions, and;
• Elicit: determine how this information pertains to the patient’s life.²

By using the elicit—provide–elicit model, the pharmacist can assuage a patient’s fears and even change their mind regarding the receipt of a flu vaccine, during a brief interaction.

Asking a patient about their concerns and or fears can also have a positive impact. Active listening and empathy can provide a patient with a feeling of comfort.³ The pharmacist should look for nonverbal clues while clearly listening to a patient’s verbal response during conversations. When responding, motivational interviewing techniques suggest that the pharmacist asks permission to provide advice when attempting to change a health-related behavior. For example, a patient may state that their friend got the flu after receiving their flu vaccine. The pharmacist may then ask, “Would it be OK if I shared some information with you?” prior to discussing how the flu vaccine does not cause the flu. By using this method, the patient and the pharmacist can have a discussion, rather than the patient perceiving the pharmacist’s comments as a lecture.

FOLLOW-UP AND FEEDBACK

Not every conversation with a patient will result in successful acceptance of a flu vaccine. No matter how well-respected and trusted the pharmacist may be to their patient, it can be difficult to move past some longstanding patient beliefs. By leaving the patient with the ability to continue the conversation in the future, the patient may perform further research on their own or think of more questions to ask at a later date. Changing behaviors and beliefs can take time, but the proper balance among listening, educating, and active discussion can be enough to engage a patient to accept an annual flu vaccine.

Urging patients to get vaccinated can be an effective follow-up method as well.⁴ If a patient has a prescription waiting to be picked up, a reminder note or customized sticker reminding them that flu vaccine is in stock and available can open discussions. Knowing what prescriptions the patient is having filled can help guide the conversation. For example, it is highly recommended for diabetic patients to receive an annual flu vaccine, so the pharmacist can share this information with the patient and encourage them to receive the vaccine at that visit, if they have not done so already. Patients in high-risk groups, such as individuals with diabetes, should be taken into account for follow-up discussions to increase rates of vaccinations in any given year.

SPECIAL CONSIDERATIONS

When considering the trivalent versus quadrivalent vaccination, it is important to note that patients should not be denied a flu vaccine or have vaccination delayed if the pharmacy only stocks 1 type of vaccine. The CDC’s Advisory Committee on Immunization Practices does not recommend 1 vaccination type over another.⁵ The trivalent vaccine contains 1 type of flu B virus and the quadrivalent vaccine contains both types of B virus; however, if a patient received the trivalent vaccination, there is no reason to revaccinate with the quadrivalent. An exception to this is in certain children (aged 6 months to 8 years) who are recommended to receive 2 doses. Please visit the Immunization Action Coalition at immunize.org for more information.⁵

Pregnant women are candidates for the flu vaccination and should receive the vaccination due to their high risk of complications from the flu.⁵ Only inactivated (not live) vaccines should be administered, and the woman can be immunized in any trimester (including her first trimester). All children aged 6 months or older should receive the flu vaccine, unless a contraindication is present.

The live, attenuated flu vaccine (LAIV) is approved to be given to healthy patients (nonpregnant) aged 2 to 49 years who are not immunocompromised.⁵ In this scenario, the patient receives the live vaccine through the dose, receiving half a dose in each nostril. Anyone receiving vaccination with LAIV should not come into contact with immunocompromised patients for at least 7 days.

Pharmacists play a key role in dispensing flu vaccines to the community. Prime accessibility, education, and strong patient relationships allow the pharmacist to build even stronger patient bonds through motivational and positive conversations sur- rounding the flu vaccination. These conversations can lead to healthier communities and positive patient outcomes.

Lauren Simko, PharmD, is a performance specialist at Pharmacy Development Services.

REFERENCES

• Hettema J, Steele J, Miller WR. Motivational interviewing. Annu Rev Clin Psychol. 2005;1:91-111.
• Butterworth S. Health-coaching strategies to improve patient-centered outcomes. J Am Osteopath Assoc. 2010;110(4 suppl 5):eS12-eS14.
• Fogarty CT, Crues L. How to talk to reluctant patients about the flu shot. Fam Pract Manag. 2017;24(5):6-8.
• O’Reilly KB. 6 ways to get your patients immunized this flu season. American Medical Association website. ama-assn.org/delivering-care/public-health/6-ways-get-your-patients-immunized-flu-season. Published November 7, 2016. Accessed May 13, 2019.
• Ask the experts. Immunization Action Coalition website; For Health Care Personnel section. immunize.org/askexperts/experts_inf.asp#workers. Updated February 28, 2019. Accessed May 15, 2019.